This is the second resubmission of an application for a Mentored Patient-Oriented Research Career Development Award (K23) to support the academic career development of the applicant. The candidate's long term goal is to develop a program of clinically-relevant, translational research focused on examining the influence and modifiability of sleep disturbance in the course and treatment of childhood anxiety disorders. Previously, the applicant has conducted research focused on the development of anxiety disorders in children and adolescents, including the prevalence of sleep disturbance. This application proposes training that is necessary for the next step in this research program, including advanced training in pediatric sleep medicine, laboratory-based training in the use and interpretation of polysomnography, assessment of neurohormonal dimensions of arousal in anxious children, and further training in research ethics and methodology. The mentorship of a select group of senior investigators will foster the candidate's development in a promising new area of research integrating two distinct areas of investigation: sleep medicine and developmental psychopathology. Prior research indicates that more than 90% of children with Generalized Anxiety Disorder (GAD) experience problems initiating and/or maintaining sleep;rates that are similar or higher than those found among adults with the disorder. Because persistent sleep disturbance during childhood is independently associated with multiple impairments in functioning including academic failure, decreased emotion regulation, decrements in attention and reasoning skills, injury risk, and risk-taking behavior, sleep problems among children with GAD may compound existing impairments, exacerbate anxiety symptoms, and result in lower recovery and higher relapse rates. The proposed study will use rigorous methods of assessment to address two primary aims: 1) to evaluate the persistence, features and daytime sequelae of sleep disturbance in children with GAD compared to a group of matched controls based on a one-week prospective, at-home assessment;and 2) to identify specific factors associated with the presence of sleep problems among children with GAD related to neurophysiologic and cognitive dimensions of arousal, and parenting and environmental factors. The training and research outlined in this proposal will equip the candidate with a unique set of necessary skills to advance knowledge in this important and under-researched area. Over the long-term, data will inform the development of empirically-based interventions for children with both sleep and anxiety disorders.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Mentored Patient-Oriented Research Career Development Award (K23)
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Study Section
Child Psychopathology and Developmental Disabilities Study Section (CPDD)
Program Officer
Churchill, James D
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Children's Research Institute
United States
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Palmer, Cara A; Clementi, Michelle A; Meers, Jessica M et al. (2018) Co-Sleeping among School-Aged Anxious and Non-Anxious Children: Associations with Sleep Variability and Timing. J Abnorm Child Psychol 46:1321-1332
Cowie, Jennifer; Clementi, Michelle A; Alfano, Candice A (2016) Examination of the Intolerance of Uncertainty Construct in Youth With Generalized Anxiety Disorder. J Clin Child Adolesc Psychol :1-9
Reynolds, Katharine C; Alfano, Candice A (2016) Things that Go Bump in the Night: Frequency and Predictors of Nightmares in Anxious and Nonanxious Children. Behav Sleep Med 14:442-56
McMakin, Dana L; Alfano, Candice A (2015) Sleep and anxiety in late childhood and early adolescence. Curr Opin Psychiatry 28:483-9
Alfano, Candice A; Patriquin, Michelle A; De Los Reyes, Andres (2015) Subjective - Objective Sleep Comparisons and Discrepancies Among Clinically-Anxious and Healthy Children. J Abnorm Child Psychol 43:1343-53
Patriquin, Michelle A; Mellman, Thomas A; Glaze, Daniel G et al. (2014) Polysomnographic sleep characteristics of generally-anxious and healthy children assessed in the home environment. J Affect Disord 161:79-83
Alfano, Candice A; Reynolds, Katharine; Scott, Nikia et al. (2013) Polysomnographic sleep patterns of non-depressed, non-medicated children with generalized anxiety disorder. J Affect Disord 147:379-84
Alfano, Candice A (2012) Are children with ""pure"" generalized anxiety disorder impaired? A comparison with comorbid and healthy children. J Clin Child Adolesc Psychol 41:739-45
Alfano, Candice A; Kim, Kerri L (2011) Objective sleep patterns and severity of symptoms in pediatric obsessive compulsive disorder: a pilot investigation. J Anxiety Disord 25:835-9
Scharfstein, Lindsay; Alfano, Candice; Beidel, Deborah et al. (2011) Children with generalized anxiety disorder do not have peer problems, just fewer friends. Child Psychiatry Hum Dev 42:712-23

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